To evaluate the efficacy of amniotic membrane in the management of painful bullous keratopathy secondary to the intractable glaucoma and in preventing exposure of drainage devices, we inserted Ahmed valve with amniotic membrane patch graft over the implant itself, and debrided corneal epithelium with amniotic membrane graft over the exposed stroma as a single operation. During the follow-up periods, we monitored vision, intraocular pressure (IOP), presence of ocular pain, and postoperative complications associated with the implants. The mean follow up period was 8.4+/-3.2 months. IOP was well controlled after the intervention. The preoperative mean IOP was measured as 43.9+/-9.0 mmHg and lowered to 16.1+/-1.8 mmHg at the last visit and no complications associated with the implants were noted. Even though the improvement in vision was not prominent, the ocular surface stabilized rapidly and ocular pain associated with bullous keratopathy disappeared soon after surgery. Conclusively the use of amniotic membrane in conjunction with Ahmed valve implantation is an effective way to relieve ocular pain and lessen the chances of complications associated with the implant in patients with intractable glaucoma and bullous keratopathy.
Retrospective Studies ; Middle Aged ; Male ; Humans ; *Glaucoma Drainage Implants ; Glaucoma/complications/surgery ; Female ; Epithelium, Corneal/pathology/surgery ; Corneal Transplantation/*methods ; Corneal Diseases/etiology/pathology/*surgery ; Amnion/*transplantation ; Aged

A case of a juvenile xanthogranuloma of the corneoscleral limbus was encountered in a 5-year-old oriental boy, who presented with a 5-month history of a lump in the right eye. The lesion extended from the inferior limbus. This yellow-orange mass was vascular and firmly fixed to the underlying tissue. The lesion was diagnosed preoperatively as an atypical dermolipoma and an uneventful excisional biopsy was performed. The pathologic diagnosis showed the characteristic picture of a juvenile xanthogranuloma with numerous Touton giant cells. Dermoid and lipodermoid tumors, as a corneoscleral limbal mass, are the most frequently encountered in childhood. A juvenile xanthogranuloma is a rare and usually benign skin disease with an unknown cause, which occurs in infants and young children. However, it can occur also as a corneoscleral limbal mass in young children.
Child, Preschool ; Corneal Diseases/*pathology/*surgery ; Human ; *Limbus Corneae ; Male ; Scleral Diseases/*pathology/*surgery ; Xanthogranuloma, Juvenile/*pathology/*surgery

PURPOSE: To describe a case of unilateral corneal keloid and present the clinical and histopathological findings and the management. METHODS: A 23-year-old Asian male patient was examined for a white spot on the left cornea that had been present since birth. On biomicroscopic examination, a well-demarcated vascularized corneal mass was found located nasal to the center. The pupil was displaced superiorly, and gonioscopic examination showed peripheral iridocorneal adhesion at 12 o'clock. The patient underwent penetrating keratoplasty. RESULTS: Histopathologic study showed a variously thickened epithelial layer, an absence of Bowman's layer, subepithelial fibrovascular hyperplasia, and an absence of dermal elements. These histopathologic findings suggested a congenital corneal keloid. The central graft cornea remained clear at 18 months after surgery and the patient was satisfied with the result. CONCLUSIONS: Penetrating keratoplasty may be an effective surgical option for congenital keloids in young adult patients.
Adult ; Corneal Diseases/*congenital/*pathology/surgery ; Humans ; Keloid/*congenital/*pathology/surgery ; Keratoplasty, Penetrating ; Male

Light microscopy and electron microscopic examination were carried out on the corneal buttons of two patients who required penetrating keratoplasty for treatment of corneal complication following the intraocular injection of silicone oil to repair recurrent retinal detachments in aphakic eyes. Light microscopic examination demonstrated increased cellularity and irregularity of collagen fibers of stromal layer, defect of endothelial cell layer and endothelial degeneration. Electron microscopy examination demonstrated marked decrease in endothelial cell population density, accompanied by flattening and thinning of the remaining cells and attenuation of cell borders. There were silicone droplets in the endothelial cell layer and collagenous layer posterior to endothelial layer. These findings are well correlated to clinical manifestation and are thought to be rather due to barrier effect of silicone oil than direct toxicity.
Adult ; Corneal Diseases/*chemically induced/pathology/surgery ; Descemet Membrane/ultrastructure ; Endothelium, Corneal/drug effects/surgery/ultrastructure ; Humans ; Keratoplasty, Penetrating ; Male ; Recurrence ; Retinal Detachment/surgery ; Silicone Oils/*adverse effects

PURPOSE: To evaluate the change of axial length (AL), intraocular pressure (IOP), and corneal astigmatism after scleral shortening with scleral invagination in the rabbit eye. METHODS: The authors performed scleral shortening (3 mm) with scleral invagination in two groups of 6 eyes each: 180 degrees (group 1) and 360 degrees (group 2). RESULTS: Average AL shortening was more prominent in group 2 (0.5 +/- 0.17 mm) than in group 1 (0.37 +/- 0.29 mm), but the difference was not statistically significant. IOP increased immediately after the procedure and was maintained at a high level through 2 months postoperatively. Induced corneal astigmatism was more prominent in group 1 than in group 2. The difference was statistically significant in group 1 (p< 0.05) but not in group 2. CONCLUSIONS: In the scleral shortening with scleral invagination procedure, a large amount of scleral invagination resulted in more shortening of axial length, but there was more corneal astigmatism in 180-degree invagination of the sclera than in 360-degree. Further research is required to determine the effect of the extent of scleral invagination on the change of these values.
Animals ; Astigmatism/*etiology ; Corneal Diseases/*etiology ; Eye/*pathology ; *Intraocular Pressure ; Postoperative Period ; Rabbits ; Sclera/*surgery

In this paper, a case of corneal squamous cell carcinoma is reported. Invasive squamous cell carcinoma of the cornea is a rare disorder and has not been previously described in the Korean literature. In this case, the invasive squamous cell carcinoma of the cornea was treated by complete excision and cryotherapy. No evidence of metastasis or recurrence has been found since the procedure. Complete excision and adjunctive cryotherapy has become the treatment of choice because of the higher recurrence rate following a simple excision.
Aged ; Carcinoma, Squamous Cell/*pathology/surgery/therapy ; Case Report ; Corneal Diseases/*pathology/surgery/therapy ; Cryotherapy ; Eye Neoplasms/*pathology/surgery/therapy ; Human ; Male ; Neoplasm Invasiveness

We report our experience with corneal epithelium, grown in vivo, transplantation in three patients with persistent epithelial defect (PED). The three patients had ocular surface disease unresponsive to standard treatments and were therefore chosen for transplantation. They underwent transplantation of epithelial sheets, grown in vivo, to the most affected eye. In vivo cultivation was carried out in the cornea of a living related donor. After epithelialization was completed, the epithelium grown on an amniotic membrane was harvested gently; it was then transplanted into the patient's eye after debridement of fibrovascular tissue. The cultivated epithelium was completely epithelialized by 2 weeks; it was well-differentiated with well-formed hemidesmosome. On immunohistochemical staining, p63, connexin 43, and Integrin beta4 were expressed in the cells on the epithelial sheet. The PED was covered completely and maintained for 4 weeks in all cases. However, corneal erosion recurred after 5 weeks in two cases. This novel technique demonstrates the corneal epithelial cells can be expanded in vivo successfully on denuded amniotic membrane of a healthy cornea and harvested safely. A corneal epithelial sheet, grown in vivo, can be transplanted to treat eye with a severe ocular surface disease, such as total limbal deficiency.
Adult ; Cell Culture Techniques ; Cells, Cultured ; Corneal Diseases/etiology/pathology/*surgery ; Corneal Transplantation/*methods ; Epithelial Cells/cytology/*transplantation ; Epithelium, Corneal/cytology/*transplantation ; Eye Burns/complications ; Humans ; Limbus Corneae/*pathology ; Male ; Middle Aged ; Stem Cells/*pathology ; Stevens-Johnson Syndrome/complications

We report two cases of band keratopathy who were treated with thick amniotic membrane that contained a basement membrane structure as a graft, after ethylenediaminetetraacetic acid chelation with trephination and blunt superficial lamellar keratectomy in the anterior stroma. In each case, basement membrane was destroyed and calcium plaque invaded into anterior stroma beneath Bowman's membrane. The calcified lesions were removed surgically, resulting in a smooth ocular surface, and the fine structures of band keratopathy were confirmed by pathologic findings. After that, amniotic membrane transplantation was performed to replace the excised epithelium and stroma. Wound healing was completed within 10 days. Stable ocular surface was restored without pain or inflammation. During the mean follow-up period of 13.5 months, no recurrence of band keratopathy was observed. This combined treatment is a safe and effective method for the removal of deep-situated calcium plaque and allowing the recovery of a stable ocular surface.
Amnion/*anatomy & histology/*transplantation ; Calcium/metabolism ; Chelating Agents/*therapeutic use ; Cornea/pathology/surgery ; Corneal Diseases/*drug therapy/pathology/*surgery ; Edetic Acid/*therapeutic use ; Female ; Humans ; Male ; Middle Aged

PURPOSE: In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium. METHODS: Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy. RESULTS: Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy. CONCLUSIONS: Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.
Animals ; Apoptosis ; Corneal Diseases/pathology/*surgery ; Disease Models, Animal ; Endothelium, Corneal/*pathology ; In Situ Nick-End Labeling ; Iris/*surgery ; Laser Therapy/*methods ; Lasers, Gas/*therapeutic use ; Ophthalmologic Surgical Procedures/*methods ; Rabbits

PURPOSE: In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium. METHODS: Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy. RESULTS: Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy. CONCLUSIONS: Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.
Animals ; Apoptosis ; Corneal Diseases/pathology/*surgery ; Disease Models, Animal ; Endothelium, Corneal/*pathology ; In Situ Nick-End Labeling ; Iris/*surgery ; Laser Therapy/*methods ; Lasers, Gas/*therapeutic use ; Ophthalmologic Surgical Procedures/*methods ; Rabbits